Tuesday, January 12, 2010

Bad science is dangerous.

The study finding that Anti-depressants don't really work on people with mild to moderate depression has only been famous for a couple of weeks. It has inspired countless conversations, a few of which I've been a part of about how these drugs don't work and are just a scam by drug companies. Most recently, I had facebook argument with someone essentially claiming that psychiatrists are quacks and don't know anything and people with mental illnesses are really just people who choose to behave differently who are punished by our society for their different choice of behaviors*.

I'm guessing THAT story will get less attention and in some cases the damage is already done.

Now THAT'S depressing.

CC

*Note that the DSM's basic approach is "sure you have symptoms, but are they bad enough to screw with your life?" So someone who is choosing to be depressed, obsessively clean, drink eight bottles of wine every day with no negative consequences for or impact on their life, would not be diagnosable under that standard.

7 comments:

hsofia
said...

I re-read that thread, and I don't think anyone said all those things in that facebook argument. There was the person who claimed that eating right can solve most mental problems (which I disagree with), and there was someone else who argued about behaviors being punishable.

That part I think has some truth to it. I have a good friend whose daughter has spent the last two years (and counting) being put through the legal system over an unpaid bus fare - she has been locked up against her will as they try to figure out what is wrong with her (two months and they couldn't diagnose her with anything, altho they tried to get her to take drugs the entire time). Oh, and she was also assaulted by the police. They couldn't understand why she (a highly sensitive, skittish person - possibly "schizophrenic" but again no diagnosis) would run away when they discovered she had no proof of fare. Hmm. Maybe because this 115lb (I'm being generous) woman was afraid that these 3 police officers would jump on her and hurt her, which they did. Meanwhile, she is dragged into court on a regular basis waiting to find out if she is going to go to prison.

So yes, behaving differently than societal norms can and do result in punishment by police and psychiatrists.

But I didn't see anyone saying psychiatrists were quacks who don't know anything, that drugs are a scam, or that all mental illness is a choice.

"I think it is useful to think of psychiatrists as police not doctors. The police are there to punish those who physically behave "wrongly" and psychiatrists are there to punish those who behave mentally "wrongly".

In medicine, doctors use as a measure of wrong function whether it harms the patient. Police use as a measure of wrongness what harms society.

Thus, any concept of "disease" for the police or psychiatrist necessarily makes reference to societal norms. Is homosexuality a disease? Why not vulgar materialism? Or religion? Socialism? Capitalism?...

Also, doctors can see physical evidence of a damaged organ lets say. For psychiatrists, there is no physiological tests to determine whether a person really is damaged mentally.

The basis of the profession literally is a bunch of psychiatrists get together every so often and decide what behaviors are diseases and which are not.

There is not way to test if their assertions are true or not. And yet these people can lock you up without trial for thought crimes."

and the later comparison to witch doctors

The witch doctor may have no "real" understanding of the problem but he/she has the most experience dealing with it in the whole society.

then I apologize, but to me the clear message is that psychiatrists are essentially making up what qualifies as a mental illness as they go along and that there is no basis for anything they are doing because it can't be proved physiologically so if they think you might be a danger to other people, they are locking you up for a "thought crime."

(By the way, the bit about the physiology not really true. Most mental illneses show up in the brain one way or another, either through expensive scanning and testing or autopsy, it's just that neither is practical for everyday diagnosis. But if you want to look there's plenty of pictures on the internet showing that the brains of Alzheimer's patients are radically altered and data about the differences in chemical balances in people with Borderline personality disorder, ditto for any other mental condition one can think of. Just because a condition can't be definitively proved until the autopsy and thus is hard to diagnose doesn't mean it's an invention of psychiatrists.)

I feel like we are reading two slightly different discussions. For example, I did mention that some conditions can be viewed in the brain, hence my complaint that patients are being prescribed mind altering drugs without any kind of physical examination. And not just in the case of mild to moderate depression, but serious, very powerful psychotropic drugs. This is common practice, and I find it worrisome. If you don't, that's okay. It's just my opinion.

I don't think anyone said that psychiatrists invent mental illness, but they certainly get to decide what is and what is not a mental illness. Hence, the homosexuality example. Also, other things that are no longer in favor such as female hysteria.

Also, if you read further in the discussion, I think you'll find that the comparison to witch doctors is intended to say that they are the best we have for the time we are in, but they are not necessarily scientific. As Feynman was referenced as saying, if you suffered an illness in a place where the doctor was a witch doctor, you see that doctor. It's preferable to seeing no one at all. The witch doctor will have the most experience in dealing with that illness simply by virtue of treating people all the time. I think you attach more negativity to this analogy than was intended.

In general, I think you are creating absolutes where there are none. When you say things like, "the clear message is that psychiatrists are essentially making up what qualifies as a mental illness as they go along and that there is no basis for anything they are doing because it can't be proved physiologically." (emphasis mine)

I think you are trying to read between the lines here, and I don't know why. In that discussion people went to great effort to clarify and qualify what they were saying. You are being dismissive of their valid criticisms and ignoring nuances when you say - and here is me paraphrasing you in the way that you have paraphrased the discussion: that they think all psychiatrists are useless quacks who just lock and drug people up for no reason. Again, no one said that. And to my knowledge, everyone (with the exception of one person, whom I need to talk to at length later about her misguided beliefs) talking about the subject has had intensely personal experience with psychiatry and therapy.

If someone is suffering, putting them through a bunch of expensive testing seems needlessly cruel when there is a less painful and cheaper method that seems to work fairly well most of the time.

(((they are the best we have for the time we are in, but they are not necessarily scientific.)))

Again, a great many mental illnesses do show up in either brain physiology or chemistry, yet the psychiatrists make their diagnoses through discussions of external symptoms that are known to correlate.

How is that 'not necessarily scientific'?

The person who quoted Feynmen sugarcoated a bit, but the full Feynman quote is as follows:

"It's a great game to look at the past, at an unscientific era, look at something there, and say have we got the same thing now, and where is it? So I would like to amuse myself with this game. First, we take witch doctors. The witch doctor says he knows how to cure. There are spirits inside which are trying to get out. ... Put a snakeskin on and take quinine from the bark of a tree. The quinine works. He doesn't know he's got the wrong theory of what happens. If I'm in the tribe and I'm sick, I go to the witch doctor. He knows more about it than anyone else. But I keep trying to tell him he doesn't know what he's doing and that someday when people investigate the thing freely and get free of all his complicated ideas they'll learn much better ways of doing it. Who are the witch doctors? Psychoanalysts and psychiatrists, of course."

In light of the clear evidence that the conditions Psychiatrists work with really do exist and that some of the drugs really help, and they know the chemical reasons why this occurs, so to me that's really Feynman shooting his mouth off about something that he doesn't really know anything about. According to a guy who was there, the psychology department stood up and left when he made that little remark.

Later in the same talk he savaged English professors as well. Amazing the number of topics that the man knew so much about that he could savage those who had dedicated their lives to them.

(((they certainly get to decide what is and what is not a mental illness. Hence, the homosexuality example. Also, other things that are no longer in favor such as female hysteria.)))

As far as the Hysteria example goes, you really think that any field of medicine is practiced in exactly the same way it was in Victorian times?

Homosexuality is a better example, but still, them being wrong about that doesn't mean that mistake makes them all unscientific witch doctors who don't know quinine from evil spirits.

(((There is not way to test if their assertions are true or not. And yet these people can lock you up without trial for thought crimes."))

Yes, if you go to a shrink and discuss your detailed plans to kill your ex-wife and the shrink believes you are actually planning to do it, the shrink has a duty to report yor threats to the ex-wife or the cops or both depending upon the state. That's not sending someone to jail for a "thought crime," in my opinion.

The usual reason one gets actually committed against one's will is a suicide attempt. Attempting suicide is not a "thought crime" it is an actual crime in almost all states and the judge has a lot more to do with a person who attempts suicide landing in an institution than any psychiatrist.

Institutionalization for any reason other than direct threats or suicide attempts is actually quite unusual. Ft has been illegal to hold someone* involuntarily without a trial for more than a brief period since like the 1970s. One example.

CC

*Who isn't a minor and hasn't committed a crime, the laws get a lot messier if one or both of those apply.

I would also just repeat that psychiatrists are experts in their field, and they can do good. At the same time, they have a great deal of power legally, medically, and culturally. The more extraordinary the claims they make, the more skepticism they should be treated with.

I would not be able to live anything like a functional life if I were not properly medicated. Though I have to navigate the inevitable side effects and though I have tried at least fifteen different medication combination over the past fifteen years, I never doubt the effectiveness of my treatment regimen.

It bothers me when people assert that mental illness is all in one's mind or that it's some kind of way that the drug companies can make money. While it is ridiculous that all of my meds would cost $1000 a month without insurance, I don't ascribe to the philosophy that going "natural" is any solution.

Yes, psychiatry is more an art form than an actual science, but this is a result of the fact that the brain is such a complex organ and that brain disorders are so difficult to understand, much less to treat. Any specialist can resort to unethical conduct.

Let me say this. Though my bipolar disorder is certainly on the severe side, such illnesses are genetic and close members of my family have mild to moderate depression and have honestly been positively helped by medication.

close members of my family have mild to moderate depression and have honestly been positively helped by medication.

Did the doctor try sugar pills first? Giving people *something* seems to affect their mental health; the question with the studies is whether medications with active ingredients that can have serious side effects are really more effective, when considered over the whole population, than placebos.

People who have chemical imbalances in their brains can be helped by correcting that imbalance through medication, just as people with diabetes can be helped by correcting their insulin imbalance. I just don't know if everyone who gets diagnosed with mild depression is suffering from an actual chemical imbalance or if plain therapy, without medication, would help some of these people who are suffering because of external life events rather than internal physiological problems.

Obviously, if something is working for someone, it would be unethical to withdraw it because of some theoretical beliefs about what "should" be the right therapy. I think there's reasonable concern, however, that the way medicine and insurance work in this country tend to push us toward pharmacological solutions before fully utilizing other options.